心电图在急性下壁心肌梗死相关动脉判定中的意义  

Usefulness of the electrocardiogram for indentifying the infarct-related artery in inferior wall acute myocardial infarction

作　　者：程何祥[1] 陈士良[1] 李伟[1] 贾国良[1] 李兰荪[1] 曹艳杰[1] 

机构地区：[1]第四军医大学西京医院心内科,陕西西安710032

出　　处：《心脏杂志》2000年第1期25-27,共3页Chinese Heart Journal

摘　　要：目的 :探讨应用心电图判断急性下壁心肌梗死患者梗死相关动脉 (IRA)的可行性与准确性 .方法 :回顾性分析 36例首次急性下壁心肌梗死患者的入院心电图与冠状动脉造影资料 .结果 :急性下壁心肌梗死患者多有右冠状动脉 (RCA)病变 (88.6 % ) ,多数 (6 6 .7% )患者有两支以上病变。IRA的分布也是 RCA多于左旋支 (L CX) ,分别占 86 .1%和 13.9%。对心电图指标 (ST ,STa VL,STV1 或 V2 ,STV2 + a VF,STV2 + ,STV5 或 V6 ,ST / )与 IRA关系的统计分析表明 ,前五组未出现显著差异。STV5 或 V6 在 RCA组多为下降 ,L CX组多为抬高而无 1例下降 (P<0 .0 5 ) ;但排除 RCA和 L CX皆有显著病变的病例后 P>0 .0 5。 ST / 在 RCA组绝大多数小于 1而 L CX组多大于 1(P<0 .0 1) ;排除 RCA和 L CX皆有显著病变的病例后仍然 P<0 .0 1。结论 :ST / 比值是判断急性下壁心肌梗死患者IRA的较准确的心电图指标。AIM:To investigate value of the electrocardiogram in predicting the infarct related artery(IRA) in inferior wall acute myocardial infarction. METHODS: The early electrocardiogram and coronary angiographic findings were retrospectively analyzed in 36 patients with first time inferior wall acute myocardial infarction. RESULTS: The right coronary artery (RCA) lesion existed in most inferior wall acute myocardial infarctions (88.6%). The ratio of RCA to the total number of infarct related arteries (IRA) was much higher than that of the left circumflex artery (LCX) (86.1% versus 13.9%).No significant correlation with IRA was found in ST Ⅰ, ST aVL , ST V 1 or V 2 ,ST V 2+aVF and ST V 2+Ⅲ groups. Patients having the RCA as IRA were significantly more likely to have ST depression in leads V 5 or V 6,whereas patients having the LCX as LRA were significantly more likely to have ST elevation in leads V 5 or V 6 ( P <0.05). After the patients with distinct lesion in both arteres were excluded, the significance disappeared ( P >0.05).The ST Ⅱ/Ⅲ ratio was >1 in most cases of the RCA group, whereas it was <1 in most cases of the LCX group ( P <0.01).After the 17 patients with distinct lesion in both arteres were excluded, the p value was almost the same ( P <0.01). CONCLUSION: The ST Ⅱ/Ⅲ ratio is an accurate electrocardiographic criteria for predicting IRA in inferior wall acute myocardial infarction.

关 键 词：梗死相关 心电图 心肌梗塞 

分 类 号：R542.220.2[医药卫生—心血管疾病]